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Cardiovascular > Hypertension 1 + 2 > Flashcards

Hypertension 1 + 2 Flashcards

1
Q

What was revealed about cardiovascular risk with regards to hypertension in the Framingham study? (2)

A
  • In men, hypertension increased risk for CHD twofold, and risk for stroke and HF fourfold
  • In women, hypertension increased risk for CHD twofold, and risk for stroke and heart failure threefold
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2
Q

What is the relationship between CV mortality and hypertension?

A

CV disease mortality risk doubles with each 20/10 (systolic/diastolic) mmHg BP increase

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3
Q

What percentage of hypertensives have additional risk factors? Examples?

A
  • 80%

* e.g. diabetes, dyslipiaemia

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4
Q

Definition of hypertension?

A

Level of BP where treatment does more good than harm

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5
Q

Recommendations for measuring BP?

A

Relaxed, temperate setting with patient quiet and seated

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6
Q

How is diagnosis of hypertension confirmed in patient with BP 140/90 mmHg?

A

Ambulatory blood pressure monitoring (ABPM)

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7
Q

What must be done if using ABPM to confirm diagnosis of hypertension? HBPM?

A
  • ABPM - at least two measurements per hour during person’s usual waking hours (usually 14/day)
  • HBPM - two consecutive seated measurements, 1 minute apart
  • BP recorded twice a day for at least 4 days
  • Measurements on the first day are discarded –
    average value of all remaining is used
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8
Q

What is stage 1 hypertension? Stage 2? Severe hypertension?

A
  • Stage 1 - clinic BP is 140/90mmHg or higher AND ABPM or HBPM daytime average is 135/85mmHg or higher
  • Stage 2 - Clinic BP 160/100mmHg or higher AND ABPM or HBPM daytime average is 150/95mmHg
    or higher
  • Severe - clinic systolic BP is 180mmHg or higher OR
    clinic diastolic BP is 110mmHg or higher
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9
Q

What does high clinic BP but low ambulatory pressure mean? High ambulatory pressure but low clinic? High clinic pressure and ambulatory pressure? Low clinic pressure and low adulatory pressure?

A
  • White coat hypertension
  • Masked hypertension (“black coat hypertension) 10-20% of patients
  • Sustained hypertension
  • True normotension
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10
Q

Rank sustained hypertension, white coat hypertension, normotension and masked hypertension in order of incidence of cardiovascular events (4)

A
  • Sustained hypertension (highest)
  • Masked hypertension
  • White coat hypertension
  • Normotension (lowest)
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11
Q

What are recommendations for assessing cardiovascular risk and target organ damage? (4)

A

For those with hypertension

  • test urine for presence of protein
  • measure blood glucose, electrolytes, creatine, glomerular filtration rate and cholesterol
  • examine funds for hypertensive retinopathy
  • 12-lead ECG
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12
Q

What is the main driver of absolute risk for hypertension?

A

Age

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13
Q

End organ damage from hypertension?

A
  • Left Ventricular Hypertrophy
  • Creatinine Raised
  • Albuminuria / microalbuminuria
  • Retinopathy
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14
Q

What are forms of established vascular disease?

A
  • Ischaemic Heart Disease
  • Cerbro-Vascular Diseased
  • Peripheral Vascular Disease
  • Diabetes
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15
Q

What are the classifications of hypertensive retinopathy? (4)

A
  • Grade I - slight or modest narrowing or retinal arterioles with atriovenous ratio >1:2
  • Grade II - modest to severe narrowing of retinal arterioles with atriovenous ratio <1:2 or atriovenous nicking
  • Grade III - bilateral soft exudates or flame-shaped haemorrhages
  • Grade IV - bilateral optic nerve oedema
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16
Q

What are signs of hypertensive retinopathy in funduscopy (ophthalmoscopy)? (3)

A
  • Haemorrhage
  • Hard exudates
  • Blurred disk
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17
Q

What are signs of grade 4 hypertensive retinopathy in funduscopy? (4) What should be done if a patient has these signs?

A
  • Flame haemorrhage
  • Papilloedema
  • Cotton wool spot
  • Hard exudates

Hospitalised

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18
Q

What is the appearance of LVH on ECG?

A

ST depression

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19
Q

What is the care for stage 1 hypertension? (3)
What about if end organ damage is present or they have 10 year cardiovascular risk >20%? What if they are younger than 40 years?

A
  • Lifestyle interventions
  • Patient education
  • Annual review to monitor blood pressure, provide support and sinus lifestyle, symptoms and medication
  • Antihypertensive drug treatment
  • Consider specialist referral
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20
Q

What is the care for stage 2 hypertension?

A

Antihypertensive drug treatment

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21
Q

What should an ACE-I not be combined with?

A

ARBs

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22
Q

In what groups of people are calcium channel blockers given instead of ACEI/ARBs? (2) What drugs are given if there is evidence of heart failure or high risk of heart failure?

A
  • Over 55 y/o
  • Black people of African or Caribbean origin
  • Thiazide-like diuretic
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23
Q

What is target clinic BP for people aged 80 and over? HBPM BP?

A
  • Less than 150/90 mmHg

* Less than 145//85 mmHg

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24
Q

What did SPRINT trials show?

A

Intensive treatment resulted in lower CV risk than standard treatment as greater decrease in systolic BP

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25
Q

Significance of twin studies with essential hypertension?

A

Show 30-50% of BP variability genetically determined

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26
Q

Factors contributing to high BP? (6)

A
  • Cholesterol
  • Triglycerides
  • Insulin
  • Hematocrit
  • BMI
  • Heart rate
27
Q

What is the importance of BP in reducing risk of stroke and CHD?

A
  • Decrease in DBP by 5mmHg results in 40% decrease in stroke risk and 25% decrease in CHD
28
Q

Common causes of secondary hypertension? (4)

A
  • Renal disease
  • Obstructive sleep apnoea
  • Aldosteronism
  • Reno-vascular disease
29
Q

Uncommon causes of secondary hypertension? (5)

A
  • Cushing’s
  • Pheochromocytoma
  • Hyperparathyroidism
  • Aortic coarctation
  • Intracranial tumour
30
Q

How does obstructive sleep apnoea cause secondary hypertension?

A

Constant stimulation of sympathetic system during the night eventually resets BP to higher level

31
Q

What is polycystic kidney disease?

A

Genetic cause of hypertension

32
Q

What percentage of hypertensive patients have inappropriate secretion of aldosterone?

A

60%

33
Q

Symptoms of pheochromocytoma? (3) How is it contracted? Cure?

A
  • Tachycardia
  • Pale
  • Episodic high BP

Genetically inherited but curable by surgery

34
Q

Renal artery stenosis? Treatment?

A
  • Renal artery does not feed kidney properly so hypotension of renal artery resulting in raised BP
  • Angioplasy and stenting
35
Q

Why is revascularisation seldom used as treatment for renal artery stenosis?

A

No benefit and substantial risk

36
Q

What is fibromuscular dysplasia?

A

Curable form of hypertension in young women, corkscrew abnormality fixed with angioplasty

37
Q

Lifestyle interventions for hypertension?

A
  • Diet
  • Alcohol consumption
  • Smoking
38
Q

Benefit of weight loss in hypertension?

A

1 mmHg for every kg lost

39
Q

Minimum amount of physical activity a day for reduced hypertension mortality? (2)

A
  • 15 min/day - 14% reduced mortality

* Every extra 15 min/day - extra 4% reduced mortality

40
Q

Benefit of reduced salt intake in hypertension? (2)

A
  • No added salt diet = reduce BP 2-4 mmHg

* Long term sodium reduction may also reduce long term risk of CV events

41
Q

Is there benefit of calcium, magnesium, potassium or combination supplements in hypertension?

A

No evidence of BP benefit

42
Q

Benefit of DASH diet?

A
  • Reduced BP in hypertensives (11.4/5.5 mmHg reduction)

* Lowest blood BP = lowest sodium intake

43
Q

Benefit of aerobic exercise?

A

Aerobic exercise reduces blood pressure 3.8/2.6mmHg

44
Q

Relative and absolute risk reduction in hypertension?

A

Lowering BP/cholesterol has same relative risk reduction but different absolute risk

45
Q

Difference in reduction of BP and thus CV event between chlorthalidone (thiazide diuretic), amlodipine (Ca++ blocker) and lisinopril (ACE-I)?

A

Identical in lowering BP and CV risk

46
Q

What are the beneficial effects of antihypertensive therapies due to?

A

BP lowering

47
Q

Benefits of antihypertensive drugs? (4)

A
  • Effect is the same across BP ranges
  • All age groups
  • Systolic and diastolic hypertension
  • All levels of CV risk
48
Q

Drugs used in treatment of hypertension? (6)

A
  • Thiazide diuretics
  • ACE-Is/ARBS
  • Ca++ channel blockers
  • B-blockers
  • Spironalactone (diuretic)
  • Alpha blockers
49
Q

Targeted treatment of antihypertensive drugs?

A
  • Thiazide diuretics - elderly
  • ACE-Is/ARBS - CCF and diabetic nephropathy
  • Ca++ channel blockers - angina
  • B-blockers - CCF and angina
  • Alpha blockers - prostatism
50
Q

Antihypertensive drug treatment in individual aged under 55 years? Resistant hypertension?

A
  • Step 1 - ACE-I or ARB
  • Step 2 - ACE-I/ARB + CCB
  • Step 3 - ACEI/ARB + CCB _ thiazide-like diuretic
  • Step 4 (Resistant hypertension) - ACEI/ARBS + CCB + thiazide-like diuretic + alpha or beta-blocker
51
Q

Antihypertensive drug treatment in individual aged over 55 years or black person of African or Caribbean origin?

A
  • Step 1 -CCB
  • Step 2 - ACE-I/ARB + CCB
  • Step 3 - ACEI/ARB + CCB _ thiazide-like diuretic
  • Step 4 (Resistant hypertension) - ACEI/ARBS + CCB + thiazide-like diuretic + alpha or beta-blocker
52
Q

Does protection with drug classes vary with age?

A

No strong evidence that protection with drug classes varies with age

53
Q

Why are ARBs often favoured over ACEIs?

A

Fewer side effects than placebo (no dry cough)

54
Q

In hypertension, should drugs be added or titrated?

A

Adding a drug
5 x more effective
than titrating

55
Q

Is combination therapy or mono therapy used in hypertension?

A

Combination therapy - has fewer side effects than mono-therapy

56
Q

What treatment is given to those with drug intolerance?

A

Multiple low dose drugs

57
Q

What are “causes” of resistant hypertension? (7)

A
  • Non-concordance
  • White coat effect
  • Pseudo-hypertension
  • Lifestyle factors
  • Drug interactions
  • Secondary hypertension
  • True resistance
58
Q

What is resistant hypertension?

A

Drug treatment fails to lower BP

59
Q

What is spironolactone? What is significant about spironolactone?

A
  • 4th line diuretic drug used in treatment of hypertension

* Most effective treatment for resistant hypertension

60
Q

When should spironolactone be used with caution?

A

In patients with diabetes and low glomerular filtration rate

61
Q

New technology for hypertension? (3)

A
  • Renal denervation
  • Baro-receptor stimulation
  • ROX coupler
62
Q

Is renal after denervation effective treatment for hypertension? Carotid baroreceptor stimulation? ROX coupler?

A
  • No, no reduction of BP in sham control
  • Yes but must wear device continuously and have carotid barorecpetor coninuously stimulated
  • Uncontrolled trial so unsure
63
Q

What is ROX procedure?

A

Central arteriovenous anastomosis for patients with uncontrolled hypertension

Cardiovascular (28 decks)

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